Parent-infant Psychotherapy Research Articles

Parenting and child mental health.

This paper reviews parenting programmes and their effectiveness with families of young children and highlights additional resources for primary care practitioners. Typically, 30% of GP consultations concern child behaviour problems and established behaviour problems can have lasting effects on children’s life chances. These problems can be identified in infancy and toddlerhood.Parenting is a key risk factor in their development and maintenance, yet is also amenable to change. In this paper we consider six parenting programmes that are widely evaluated and/or available in the U.K. and their evidence base . These include two NICE recommended parenting programmes (Incredible Years and Triple P), which offer tiered and flexible parenting programmes; predominantly for parents of school-age children. We also review Parent–Infant Psychotherapy, which is typically for parents of younger children. Fourth is Family Nurse Partnership, an intensive programme to support young, first-time mothers. Finally we consider, video feedback programmes which use video to focus in detail on parents’ interactions with their children, including Video Feedback to Promote Positive Parenting and Video Interactive Guidance. These interventions demonstrate the range of approaches which are being used to intervene early in children’s lives to try to prevent the development of enduring behavioural problems.Why this matters to meIt is becoming increasingly clear that the origins of many mental health problems lie in childhood. Family factors, including the quality of care that parents provide for their children, can make a huge difference to children’s early life pathways, for better or for worse. Understanding how best to intervene to support parents is a key challenge. In this article, we critically review the most widely used parenting programmes for parents of young children. It is imperative that we judge these early interventions to high standards so that we are offering children the best start in life.Key messageParenting programmes offer a means to intercept behaviour problems in early childhood before they become established.

Parent–infant psychotherapy for improving parental and infant mental health

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Does the evidence support parent-infant psychotherapy?

SummaryParent–infant psychotherapy (PIP) is a psychoanalytic intervention that aims to improve parental and infant mental health. There is uncertainty about the clinical effectiveness of this intervention, particularly in comparison with other interventions. Based on a limited number of trials, this month's Cochrane Corner review aimed to summarise the best evidence available. Although the review found some tentative support for PIP in relation to attachment outcomes, overall the evidence was of low quality and PIP was not found to be more effective than treatment as usual or other interventions. This commentary contextualises and summarises the findings, and considers their implications for researchers and clinicians.

On Traumatically Skewed Intersubjectivity

ABSTRACTBeginning with his Interpersonal World of the Infant (1985), Daniel Stern suggested that the infant is driven from birth to connect intersubjectively with his caregivers. By the final three months of the first year of life, as the infant begins to use protodeclarative pointing and jointly attends to the outer world, he also begins to jointly attend with his caregiver to their respective intrapsychic worlds, the mental states of his caregiver and himself. Clinically, analysts observe at this crucial point of development of secondary intersubjectivity mothers who, more often than not, respond only selectively and often unpredictably to their infants. In many instances, this may be motivated out of a mother’s own need for regulation of emotion and arousal as we have shown in our empirical research. This article elaborates on clinical observations that, for the infant or young child to feel his traumatized mother’s affective presence, he must try to enter mother’s state of mind, while simultaneously, mother is seeking to self-regulate in the wake or the revival of trauma-associated memory traces, this at the expense of mutual regulation of emotion and arousal. We call this phenomenon traumatically skewed intersubjectivity. We find that children coconstruct with their traumatized mothers a new, shared traumatic experience by virtue of the toddler’s efforts to share an intersubjective experience with a mother who is acting in response to posttraumatic reexperiencing. The problem is that the infant or young child has no point of reference to decipher the traumatized mother’s social communication. And so, what is enacted leads to a new, shared traumatic event. Both the child’s anxiety and aggression can, in this setting, easily become dysregulated, further triggering mother’s anxiety and avoidance, leading thus to a vicious cycle that contributes to intergenerational transmission of trauma. Clinical examples and implications for psychoanalytically-oriented parent-infant psychotherapy will be discussed.

How does video interaction guidance contribute to infant and parental mental health and well-being?

This article describes the contribution of video interaction guidance (VIG) to the development of infant and parental and VIG practitioners' mental health and well-being. The theoretical core of VIG was depicted in terms of concepts such as intersubjectivity, attunement and mediated learning. The way the VIG principles alongside the underpinning values and beliefs promote a process of attunement between parent and infant, the VIG practitioner and parent, and the VIG practitioner and supervisor is described. This article also describes some of the evidence about the effectiveness of video feedback techniques more generally and the way in which the underpinning theory of change enables VIG to target key ports of entry in terms of areas that have been highlighted by numerous epidemiological studies as being important in terms of supporting or derailing infant attachment security. A case study is used to demonstrate the way in which VIG can be integrated within broader therapeutic approaches such as parent-infant psychotherapy to support the interaction of parents who have been deeply traumatised in childhood. It also demonstrates how the parallel process of practitioner 'attunement' to mother is key to the mother's recovery and her new ability to form attuned relationships herself with her children and other adults.

The Study and Treatment of Mothers and Infants, Then and Now: Melanie Klein’s “Notes on Baby” in a Contemporary Psychoanalytic Context

This paper draws on Melanie Klein’s (unpublished) observational notes of her infant grandson, written primarily in 1938 and 1939. Apart from moving glimpses into a young family’s life, the notes contain astute observations of an infant’s behavior and emotions. Compared with Klein’s published writings, the style is less theoretical and polemical. Later, in his latency years, Klein’s grandson was in analysis with Marion Milner, who in 1952 published a paper drawing on the treatment.The present paper focuses on (1) how observations and treatment of the same child and his family by clinicians in close relationships with each other (Klein, Milner, and Winnicott) fertilized reciprocal influence but also brought into question the validity of Klein’s observations, and (2) the relative merits and contributions of various modalities in understanding the infant’s psyche, including experimental research, direct observation, parent–infant psychotherapy, and reconstructions from older patients—as occurs, for example, in psychoanalysis.

Building relational possibilities: theoretical roots of infant mental health practice in the case of Alycia

The practice of infant mental health (IMH) has evolved from a combination of theoretical frameworks focused upon early relationships and the complex interplay between individuals and their internal and external worlds. The main components of IMH practice: developmental guidance; emotional support; parent–infant psychotherapy; concrete support; and advocacy, demonstrate a connection between psychoanalytic theoretical frameworks and social work values and forms the basis of practice for IMH therapeutic programmes. This paper will trace the theoretical roots of IMH practice and utilise a clinical case example to illustrate the ways in which insights from object relational, self psychological and attachment theories are integrated into IMH home visiting practices.

Clinical interventions via Skype with parents and their young children

In this article, the author discusses her experience of working with six families from two Greek islands. She focuses on her reflections and reservations on using cyber-communication technology in brief psychoanalytic parent–infant psychotherapy. Communication technology may be a useful way of providing support to families with young children living in remote areas without mental health services. Advances in cyber-communication have created the possibility of offering timely, primary mental health care to prevent difficulties becoming chronic and complex. The parent–infant psychotherapy focuses mainly on emotional difficulties related to stress in the parents’ and infant’s life and on transgenerational problems. The use of cyber-communication (Skype) for this work raises many issues and difficulties and the need for changes in technique, the expectation of technical difficulties and interruptions, the absence of physical proximity, differences in establishing the therapeutic relationship, the working alliance, transference and counter transference phenomena and in the power of unconscious processes.

REFLECTIVE PRACTICE IN INFANT MENTAL HEALTH-A SOUTH AFRICAN PERSPECTIVE.

Reflective practice forms a pivotal part of mental health intervention in a setting where language and cultural differences require working together with a community counselor for language interpretation. Reflective practice in infant mental health began with Esther Bick's () infant observations and continued with Selma Fraiberg's () parent-infant psychotherapy. These two models formed the basis of the practice of infant mental health in a community in South Africa. A clinical example will highlight the importance of culturally informed observation that is then reflected upon. A qualitative study that examined the interaction among the participants in three clinical settings shows that a sustained partnership and tolerance for flexibility lie at the heart of good practice in intercultural settings. Object-relations theory offers an additional, in-depth understanding of the underlying psychic processes in reflective practice.

Parent–infant psychotherapy: a systematic review of the evidence for improving parental and infant mental health

Background: Parent–infant psychotherapy (PIP) is a psychodynamic intervention with parent–infant dyads, designed to address regulatory disturbances in infancy and problems in the parent–infant relationship.Aims: This systematic review aimed to examine whether PIP is effective in improving the parent–infant relationship or other aspects of parent or infant functioning.Methods: A systematic review was undertaken. Electronic databases were searched for randomised controlled trials in which participants had been allocated to a PIP intervention or control group/other treatment.Results: Eight studies were identified that provided data comparing parent–infant psychotherapy with a no-treatment control group (four studies) or comparing PIP with other kinds of treatment (four studies). Meta-analyses indicated that parents who received PIP were more likely to have an infant who was rated as being securely attached to the parent after the intervention; however, there were no significant differences in studies comparing outcomes of PIP with another model of treatment.Conclusions: Although PIP appears to be a promising method of improving infant attachment security, there is inconclusive evidence of its benefits in terms of other outcomes, and no evidence to show that it is more effective than other interventions for parents and infants. Many studies had limitations in their design or implementation, and findings must be interpreted with caution.

RANDOMIZED CONTROLLED TRIAL OF PARENT-INFANT PSYCHOTHERAPY FOR PARENTS WITH MENTAL HEALTH PROBLEMS AND YOUNG INFANTS.

There is a dearth of good-quality research investigating the outcomes of psychoanalytic parent-infant psychotherapy (PIP). This randomized controlled trial investigated the outcomes of PIP for parents with mental health problems who also were experiencing high levels of social adversity and their young infants (<12 months). Dyads were clinically referred and randomly allocated to PIP or a control condition of standard secondary and specialist primary care treatment (n = 38 in each group). Outcomes were assessed at baseline and at 6-month and 12-month follow-ups. The primary outcome was infant development. Secondary outcomes included parent-infant interaction, maternal psychopathology, maternal representations, maternal reflective functioning, and infant attachment. There were no differential effects over time between the groups on measures of infant development, parent-infant interaction, or maternal reflective functioning. Infant attachment classifications, measured only at the 12-month follow-up, did not differ between the groups. There were favorable outcomes over time for the PIP-treated dyads relative to the control group on several measures of maternal mental health, parenting stress, and parental representations of the baby and their relationship. The findings indicate potential benefits of parent-infant psychotherapy for improving mothers' psychological well-being and their representations of their baby and the parent-infant relationship.

Review: Attachment and attachment‐related outcomes in preschool children – a review of recent evidence

Secure attachment is associated with optimal outcomes across all domains in childhood, and both insecure and disorganised attachment are associated with a range of later psychopathologies. Insecure and disorganised attachment are common, particularly in disadvantaged populations, pointing to the need to identify effective methods of addressing such problems. This paper presents the findings of a review of secondary and primary studies evaluating the effectiveness of interventions aimed at improving attachment and attachment-related outcomes on a universal, targeted or indicated basis, which was undertaken as part of an update of the evidence base for a UK-based national programme targeting children aged 0-5years (Healthy Child Programme). A systematic search of key electronic databases was undertaken to identify secondary and primary sources of data that addressed the research question and that had been published between 2008 and 2014; search sources included Cochrane Collaboration, NICE, EPPI Centre, Campbell Collaboration and PubMed, PsychInfo, CINAHL databases. Six systematic reviews and 11 randomised controlled trials were identified that had evaluated the effectiveness of universal, selective or indicated interventions aimed at improving attachment and attachment-related outcomes in children aged 0-5years. Potentially effective methods of improving infant attachment include parent-infant psychotherapy, video feedback and mentalisation-based programmes. Methods that appear to be effective in improving attachment-related outcomes include home visiting and parenting programmes. A number of methods of working to promote attachment and attachment-related outcomes in preschool children are now being recommended as part of the Healthy Child Programme. The implications in terms of the role and contribution of practitioners working in child and adolescent mental health service are discussed.

Parent-infant psychotherapy for improving parental and infant mental health.

Parent–infant psychotherapy (PIP) is a dyadic intervention that works with parent and infant together, with the aim of improving the parent–infant relationship and promoting infant attachment and optimal infant development. PIP targets the mother’s view of her infant, linking her own early

Mind Strings

Click to increase image sizeClick to decrease image size Additional informationNotes on contributorsFrancoise JaffeFrancoise Jaffe, LCSW, PhD, completed her training in the NIP adult program in 2014. After receiving her MSW from NYU, she attended the Columbia University PIP program, observing infants and learning about parent–infant psychotherapy, while also enrolled in child and adolescent psychotherapy studies at NIP and IPTAR. Before entering the field, she was an assistant professor of marketing at the University of Michigan Business School from 1985 to 1993. Currently, she is in private practice in New York City and Westport, CT. Address correspondence to Francoise Jaffe via e-mail: francoise.jaffe@gmail.com

Parent‐infant Psychotherapy for Improving Parental and Infant Mental Health: A Systematic Review

Parent‐infant Psychotherapy for Improving Parental and Infant Mental Health: A Systematic Review

"New beginnings" in South African shelters for the homeless: piloting of a group psychotherapy intervention for high-risk mother-infant dyads.

The New Beginnings program was developed at the Anna Freud Centre and originally piloted in Her Majesty Prisons in the United Kingdom. This study aimed to explore the use of this manualized parent-infant psychotherapy group model in an African setting with high-risk mother-infant dyads, and describes the implementation and investigation of this 12-week group psychotherapy intervention in two Johannesburg shelters for homeless women. The measures used to investigate treatment efficacy were the Parent Development Interview (A. Slade, J.L. Aber, I. Bresgi, B. Berger, & M. Kaplan,), the Emotional Availability Scales (Z. Biringen, J.L. Robinson, & R.N. Emde,), the Kessler-10 (R.C. Kessler et al.,), and the Griffiths Scales of Mental Development (D. Luiz et al., . At pretesting, infants exhibited delays in a number of developmental areas, and mothers showed high levels of depression and generally low capacities for reflective function. While significant shifts in the mothers' capacities for reflective function were not found in the treatment condition, significant shifts were found in the infants' speech abilities and in the mothers' abilities to structure their interactions with their infants. This suggests that the program enabled mothers to become more sensitized to their infants' needs in interaction and that communication between mother and infant increased. The number of sessions attended by the dyads correlated with improvements made by the mothers and their infants.

Response to Alonim and Schore: Containment, Origins of the Self, and Pathways to Autism

Hannah Alonim and Allan Schore comment on my article “The Protest of a Six Month Old Girl: Is This a Prodrome of Autism?,” an account of the infant-parent psychotherapy of a baby with attachment problems and possibly autistic defenses. In response, I address the points of convergence and divergence between the commentators and myself: the distinction between attachment disorders and autism, the contribution of the concept of “containment,” and the timeline for the differentiation of self from other. I also reflect on Schore’s and Alonim’s contributions to the cultural landscape of autism research and treatment.

Flexing the frame: contemplating the use of multiple ports of entry in parent-infant psychotherapy.

Multirelational interventions are well described in the psychoanalytic parent-infant literature. Daniel Stern (1995) originally suggested and described five "ports of entry" that may be employed to access the multiperson parent-infant clinical system. Other authors have elaborated and extended Stern's original list of ports of entry. The impact of using multiple ports of entry on the psychoanalytic frame, however, is largely neglected in the parent-infant psychotherapy literature. Danielle Quinodoz's (1992) four facets of the psychoanalytic setting are used to structure a discussion of how the multiplicities associated with parent-infant psychotherapy may impact the frame. The article argues strongly for a necessary flexing of the psychoanalytic frame to establish therapeutic alliances. A fifth facet, that of psychoanalytic mindfulness, is offered as a counterbalance to the risks associated with excessive flexing of the frame, particularly in relation to Quinodoz's fourth facet of "refraining from 'doing.'" This article relies on case material to illustrate the issues under discussion. Further engagement and debate are invited.

Treatment – Mother–infant relationship psychotherapy

In this chapter, we briefly describe several modes of parent-infant-psychotherapy, an efficient way of treating parent-infant relationship disorders. We then focus on treatment for postnatally depressed mothers. Perinatal depression defines an episode of major or minor depression occurring during pregnancy or the first 12 months after birth. Attachment-based parent-infant interventions are particularly helpful in the context of maternal perinatal depression, as postpartum depression has a special link with unresolved trauma and losses in the mother's childhood. The goal of treatment is to improve the mother's mood but also to prevent or reduce the effects of postpartum depression on the child. Infants of perinatally depressed mothers are at risk for a large array of negative outcomes, including attachment insecurity (particularly disorganised attachment), social-skills deficits, cognitive difficulties, behaviour problems, and later psychopathology. The 'ghosts in the nursery' concept refers to the painful or disturbed early childhood experiences coming from the mother's past, which haunt the present mother-infant relationship. By addressing the mother's unresolved attachment conflicts (in her relationship to her own parents), it is believed that the development of a more adaptive parenting and a more secure and less disorganised attachment between the mother and her infant is facilitated. Changes in parent- infant interaction are not dependent on the port of entry (e.g. child's behaviour, parent's representation or parent-infant relationship). The perspective of attachment is key to install a therapeutic alliance with parents.

Maternal Representations and Mother-Infant Relational Behavior Following Parent-Infant Psychotherapy

To examine how relational behavior and maternal representations are manifested before and after parent-infant psychotherapy, mothers’ and infants’ behaviors and maternal narratives were assessed in 45 clinic-referred dyads who participated in psychodynamically informed parent-infant psychotherapy. Pretreatment and posttreatment assessments included observations of mothers’ and infants’ behaviors (CIB; Feldman, 1998) and assessment of maternal representations (PDI; Aber, Slade, Berger, Bresgi, & Kaplan, 1985). Parent-infant psychotherapy consisted of weekly child-mother, child-father, and two parents’ sessions. Following psychotherapy, maternal sensitivity and child engagement showed a significant increase. An increase was also evidenced in the richness of maternal narratives regarding the mother-infant relations. During the pretreatment assessment, maternal intrusiveness was associated with restricted narratives, lack of joyful descriptions, and reduced coherence and child engagement was associated with maternal narratives characterized by incoherence and reduced joy. Maternal reports of high psychological distress were associated with higher maternal intrusiveness and lower maternal sensitivity following psychotherapy. Discussion focuses on the unique opportunities for infants in parent-infant psychotherapy as well as the need for further understanding of the processes underpinning change following this treatment modality.